Cushing Versus Addison Disease
- Addison Disease or Addison’s DiseaseÂ
- Cushing Syndrome or Disease or Cushing’s Syndrome or Disease. Â
- The ‘s is a matter of preference. Both forms are acceptable.
Aldosterone is a mineralcorticoid
Aldosterone is super important! Know what it does. It increases sodium and decreases potassium. Too much aldosterone: High Na+/Low K+. Too little Aldosterone: Low Na+/High K+.
- So the pituitary releases ACTH to tell the adrenal glands to release cortisol. Too much cortisol, less ACTH needed since there is no need to tell adrenals that cortisol is needed. Too little cortisol released by adrenals, then pituitary ↑ ACTH release.
- Pay attention here. Addison is low cortisol (need to ADD hormone) since cortisol is low, ACTH is high. The pituitary keeps increasing ACTH (without success) to increase cortisol. Addison= ↓ cortisol and ↑ ACTH
- Cushing is the opposite=When the problem is the adrenal glands there is ↑ cortisol and ↓ ACTH. The ↑ cortisol tells the pituitary gland to ↓ ACTH. Unless it is a pituitary problem in which the pituitary keeps releasing ACTH which stimulates adrenal glands to ↑ cortisol.
Steroids
Decrease immune function (High risk for INFECTION) and decrease calcium absorption and increase breakdown (OSTEOPOROSIS)
Steroid Alert
Never stop steroids abruptly. TAPER. Let me say it again, TAPER. Abruptly stopping steroids may cause ADDISONIAN CRISIS. When you give too much steroids (or for a long time), the adrenal glands start thinking "I don't have to do anything anymore. I will stop working since there are "exogenous steroids" available. So reduce dosage or taper to give time for adrenal glands to wake up and do their job.
This is an Alert
Long-term use of steroids causes Cushing Syndrome. After a while, you start seeing the acne, the moon face, the truncal obesity, osteoporosis, high risk for infection and so on and on. NCLEX loves it when you know that steroids can cause: gastric ulcers, cataracts, and osteoporosis so watch for gastric discomfort, bad vision, and joint pain! Say it again: watch for gastric discomfort, bad vision and joint pain when on steroids.